Without reform, the NHS will never have enough staff
It is accepted wisdom that the NHS is desperately short of staff. We regularly hear reports of the record number of vacancies and the need to use expensive agency cover. Yet the NHS in England employs the full time equivalent of 1.2 million people, nearly 200,000 more than they did in 2012. The increases in staff numbers are accelerating. The Institute for Fiscal studies has found there are 10.7% more nurses and 10.2% more hospital consultants than in 2019. The government is also on course to meet its target of having an extra 50,000 nurses in place by 2024.
The whole piece covers familiar ground but is well worth reading. For example, this paragraph makes a telling point.
Much of the problem is that NHS lacks many of critical elements of good organisational management. The fact that 12600 operations were cancelled last year due to administrative errors is just one indicator of this. Huge amounts of money has been wasted on commissioning management consultants to identify solutions but their reports are never implemented because the culture of the NHS resists and subverts any such changes in working practices.
In my experience, worthwhile reform of the public sector certainly can be subverted from within, and not necessarily at a senior level.
It is accepted wisdom that the NHS is desperately short of staff. We regularly hear reports of the record number of vacancies and the need to use expensive agency cover. Yet the NHS in England employs the full time equivalent of 1.2 million people, nearly 200,000 more than they did in 2012. The increases in staff numbers are accelerating. The Institute for Fiscal studies has found there are 10.7% more nurses and 10.2% more hospital consultants than in 2019. The government is also on course to meet its target of having an extra 50,000 nurses in place by 2024.
The whole piece covers familiar ground but is well worth reading. For example, this paragraph makes a telling point.
Much of the problem is that NHS lacks many of critical elements of good organisational management. The fact that 12600 operations were cancelled last year due to administrative errors is just one indicator of this. Huge amounts of money has been wasted on commissioning management consultants to identify solutions but their reports are never implemented because the culture of the NHS resists and subverts any such changes in working practices.
In my experience, worthwhile reform of the public sector certainly can be subverted from within, and not necessarily at a senior level.
4 comments:
It's difficult for non-specialists to identify the main problems in the NHS. We have dozens of personal anecdotes and even lists of pertinent facts like those in the article. But I struggle to think of key reasons as to why things have gone wrong because I don't have the administrative expertise regarding how patients are seen and sorted, staff recruited and paid, and how equipment is bought. I have known people working in the NHS who could shoot down any arguments I make or repeat, and sound quite plausible when doing it. Even the stats: there would be good reason why they are the way they are.
So I tend to back right off and think about things that I do understand as well as most people. The most relevant seems to be that the NHS - with its aura of emotion surrounding pain, sickness, death, and selfless heroism - is a subject upon which people are particularly prone to exaggerate and lie. On the one hand, in our village we have a hospital worker who gets weepy and distressed when describing the hell of a covid ward. On the other we have eyewitness accounts of prefab Nightingale Hospitals being quietly dismantled at night because they were never needed. The NHS is a political football for Governments, and an emotional football for anyone who wants to take a punt at it.
Recently the NHS told me they'd cancelled my appointment and replaced it with another. (i) The initial appointment had never existed - or more precisely if it had existed they'd never told me about it. (ii) They communicated this message with an email and three different letters, all four saying the same thing.
This was a different department from the one that recently told me on arrival that they'd cancelled my appointment and I should come back in January. I dug my heels in. Eventually I was seen. As my wife drove me home I predicted that they'd fake an email telling me that the appointment had been cancelled. And indeed they had - rather pointlessly since the email was time-stamped of course.
An awful lot of dealing with the NHS becomes a matter of dealing with their insults to our intelligence.
20 years ago, or so, there were many senior managers leaving the business by early retirement. I too was a manager in. I said at the time that although all these people were not necessarily wonderful managers they did have a different attitude about managing change and a desire to see it through.
Perhaps we should 'graft' these retired managers onto the NHS rootstock? If nothing is done to change the sacred NHS it will stagger on, good in parts, until it falls over with a mighty crash.
Sam - "...a subject upon which people are particularly prone to exaggerate and lie."
And the tendency has expanded to the environment and wider social and political issues. There seems to be something fundamental preventing us from being collectively hard-headed in all cases.
dearieme - and they guard themselves against any challenge to those insults to our intelligence. They know they are doing it, but do it from a fake moral high ground, so in their eyes it's okay.
DJ - that was my experience, older managers retired early and although they weren't wonderful managers, they understood what they were doing. Then the MBA approach came in and things went downhill quite rapidly.
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